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FUNGAL INFECTION

Group of organisms that include yeast and


molds which are usually not pathogenic
Grow best in unsanitary conditions with
warmth, moisture and darkness
Infections generally occur in keratinized
tissue found in hair, nails and stratum
corneum
Dermatophytes (Ringworm fungi)
Cause of most skin, nail and hair fungal
infections

Tinea capitis
is a dermatophytosis of the scalp and associated
hair
it may be caused by any pathogenic
dermatophyte from the genera Trichophyton
and Microsporum exepting T. concentricum

Black dot tinea capitis caused by Trichophyton tonsurans

Tinea capitis caused by


Microsporum audouinii

Tinea capitis gray patch type.


A large, round hyperkeratotic
plaque of alopecia due to
breaking off of hair shafts close
to the surface.

Kerion: heavily crusted, hairless plaque

Kerion: red, oozing, hairless


plaque
Permanent scarring alopecia post kerion

Tinea corporis
Refers to all dermatophytoses of glabrous skin except
the palms, soles, and groin
The classic presentation is an annular lesion w/ scale
across the entire erythematous border.
The border is often vesicular and advances
centrifugally.
The center of the lesion is usually scaly but may
exhibit clearing
Lesions may be serpiginous and annular ring-wormlike)

Tinea corporis: large gyrate plaque with


advancing border, typical ringworm-like
configuration

Tinea imbricata: concentric ring of


scale caused by T. concentricum

Annular tinea corporis on the thigh. Note


multiple, confluent annular lesions w/ a
scaly and partially vesicular border. This
type of lesion is usually seen w/ zoophilic
dermatophytic infection

Polycyclic pattern of tinea corporis


resembling psoriasis

Tinea Cruris
Usually appears as multiple erythematous
papulovesicles w/ a well-marginated, raised border
Pruritus is common, as is pain w/ maceration or
secondary infection

Tinea cruris. Scaling erythematous


plaque w/ sharp margins in the
inguinal and pubic region

Tinea Pedis and Tinea Manus


Tinea pedis may present as any of the four forms, or a
combination thereof
Chronic intertriginous type (Interdigital type)
Chronic hyperkeratotic type
Vesiculo-bullous type
Acute ulcerative type

Tinea pedis, interdigital. The area


is macerated and has opaque
white scales and some erosions

Tinea pedis. Superficial white scales in a


moccasin-type distribution.Note
archiform pattern of the scales,
which is characteristic

Two feet-one hand presentation


of Trichophyton rubrum

Tinea pedis, bullous type. Ruptured


vesicles, bullae, erythema, and
erosion on the plantar aspect of the
great toe

Onychomycosis
Any infection of the nail caused by dermatophyte
fungi, nondermatophyte fungi, or yeast
4 clinical types:
Distal subungual onychomycosis
Proximal subungual onychomycosis
White superficial onychomycosis
Candidal onychomycosis

A. Distal subungual onychomycosis occuring


simultaneously with superficial white
onychomycosis

B. white superficial onychomycosis

Candidiasis
Diverse group of infections caused by Candida
albicans or by other members of the genus Candida
These organisms typically infect the skin, nails,
mucous membranes, and gastrointestinat tract, but
they also may cause systemic disease

Pseudomembranous candidiasis or
thrush. Note the characteristic white
patches on the palate

Candida perleche w/ erythema and


fissuring at the corners of the mouth

Hyperplastic candidiasis of the tongue

Note the superficial erosion and moist area


with ulceration which are surrounded by
erythematous papules. These satellite
lesions are typically associated w/ chronic
which are found outside the larger
affected areas

Red, partially eroded plaques on


the vulva surrounded by a delicate
collar in an infant. Outside the
main lesions are few pustular
satellite lesions

Candida in potassium hydroxide


preparation showing pseudohyphae
and yeast forms

Treatment
Oral candidiasis
Uncomplicated: Nystatin suspension (400.000-600.000
unit 4x/d) or
In recurrent cases, oral azoles are proven to be more
effective
Candidal intertrigo
Topical antifungals including nystatin and topical
imidazole cream
Miconazole powder can be use to dry moist intertriginous
areas
Candidal paronychia
Chronic paronychia due to Candida is resistant to therapy
Topical imidazole in solution form is the ideal tx
Oral ketokonazole may be used

Pityriasis versicolor
Caused by Pityrosporum orbiculare, previously called
Malassezia furfur
Sharply defined, yellowish-brown macules w/ tiny
scales
KOH prep: spaghetti and meatball-like hyphae and
spores

Tinea versicolor infant

Tinea versicolor, upper chest in teenager